Shortage of doctors in rural Spain is increasing

by Lorraine Williamson
rural doctors

Half of the 11,000 remaining doctors in rural Spain could retire within five years. They say they don’t have replacements. Young doctors are not encouraged to choose the countryside.

Closer to the patient, a stronger sense of community and a more comfortable lifestyle than in the city. These are some of the benefits that rural doctors find in their profession. In Spain, between 11,000 and 15,000 doctors work in municipalities with fewer than 15,000 inhabitants. The spread is so wide because there is no official data on the number of doctors working in rural areas.

Many doctors in rural areas retire within five years

According to estimates by the Spanish Society of Family and Community Medicine (semFYC), around 4,500 will retire in the next five years. In the best-case scenario, we are talking about a third; at worst, about almost half of rural doctors in Spain.

Young doctors choose to live in the city or abroad

The fact that there are young doctors who do not choose the countryside is a huge loss that we cannot afford,” Mavi Carceller, a general practitioner and member of the semFYC Working Group on Rural Medicine, told the Spanish news service EL ESPAÑOL.

According to her, there are two reasons. On the one hand, they are hampered, they are not incentivised, and they are not offered stable contracts. On the other hand, they do go abroad because they are well-educated and speak languages.

Rural areas cannot do without primary care

“If you improve conditions, maybe there will be people who will work in rural areas. If not, rural medicine will perish.” These are the words of Alfonso Barquilla, member of the National Board of Directors of the Spanish Association of Doctors of Primary Care (Semergen). “In the city, the system can function without primary care. But in rural areas, it’s impossible,” he continues.

Barquilla knows what he’s talking about. He has spent almost 40 years of his life practicing rural medicine in two villages near Trujillo (Cáceres). He, like many others, thought that things would get better after Covid-19. But feeling abandoned by both the government and the patients, he decided to retire. He regrets that the doctor’s image has deteriorated: “The relationship with the patient used to be closer than it is now.”

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Lack of replacement in case of sick leave or vacation

When he retired, he realied how difficult it would be for his patients — and also for his neighbors — to find a replacement. “In the first four months, my place was occupied by as many as seven doctors. And we are lucky to be relatively close to the capital. Because the further away you go, the harder it is to fill those positions. He jokes that his patients are tired of knowing so many doctors.

This lack of doctors is not only felt when someone retires. “In the past, during sick leave or vacation, our work was done by another GP. Now we are practically never replaced,” Carceller laments. “This comes at the expense of the quality of our care and the safety of our patients,” she adds.

This general practitioner from the health centre in Getaria, a municipality in Guipúzcoa with about 2,800 inhabitants, feels “privileged” because she does not have to move between different cities, as many of her colleagues do. In fact, the Federation of Medical Unions of Castilla y León recently demanded a car with a driver to be able to work in rural areas.

Fear of loneliness

Both Carceller and Barquilla grew up in the countryside. Therefore, they know better how these societies work and feel more comfortable in a village than in a city. “You have to have it in your blood,” Barquilla says. He adds that doctors in rural areas are viewed with more respect than in urban areas.

They suspect that young doctors in rural Spain are afraid of feeling lonely. But with the normalisation of technology, that would not be the case as it used to be. It also doesn’t help that future graduates hardly experience what it’s like to be a country doctor. It is true that they have to work in the countryside for about three months during their internship. But, as Barquilla points out, this usually happens in cities with 10,000 inhabitants just a few minutes away from the capital.

“If they don’t know how to work two hours from a hospital, it’s harder for them to decide to stay,” he says. In this way, they do not fully experience the intensity with which they work in the countryside. “If we can name an advantage, it’s to be close to your patients, to get to know them. When they come in, you don’t even have to ask them about their background.”

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